Endoscopic placement of a self-expandable metal stent for malignant small-intestine obstruction using a digital cholangioscope-guided approach

For malignant gastrointestinal obstruction in inoperable patients, the self-expandable metal stent (SEMS) is a useful nonsurgical palliative treatment to improve patients’ quality of life [1] [2] [3] [4]. The common method of intestinal stent placement is to navigate the guidewire through the narrow segment, which often takes a long time, and sometimes leads to stent placement failure because the guidewire cannot pass through the narrow segment. Here, we describe the successful endoscopic placement of an SEMS using a guidewire after a digital cholangioscope was used to pass through the narrow small intestine.

A 46-year-old man was diagnosed with unresectable primary carcinoma of the horizontal segment of the duodenum with severe intestinal obstruction. After failure of conventional stent placement, we attempted to use a digital cholangioscope to place the guidewire through the narrow segment and guide the SEMS ([Video 1]). First, a digital cholangioscope (eyeMax; Micro-Tech Nanjing, Co., Ltd, Nanjing, China) was inserted through the stenosis and a 0.35-mm guidewire was introduced into the distal small intestine under direct visualization ([Fig. 1]). After retrieval of the digital cholangioscope, the uncovered SEMS was advanced over the wire through the stenosis and gradually deployed under continuous X-ray monitoring ([Fig. 2]). Stent patency was evaluated with iodine contrast agent immediately after placement ([Fig. 3]).

Video 1 Endoscopic placement of a self-expandable metal stent was performed using a digital cholangioscope-guided approach.

Fig. 1 Guidewire placement into the distal small intestine under direct visualization using a digital cholangioscope. a A digital cholangioscope was inserted through the stenosis. b A 0.35-mm guidewire was placed into the distal small intestine under direct visualization.

Fig. 2 Endoscopic view of the stent placed for the treatment of intestinal obstruction due to primary carcinoma of the horizontal segment of the duodenum.

Fig. 3 Stent patency was evaluated immediately after placement using X-ray with iodine contrast agent.

The patient was allowed to drink clear liquid on the second day after the operation, and advanced to a low-residue diet on the third day.

For patients with intestinal obstruction, this technique is a fast and effective method for stent placement.

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• References

• 1 Park H, Do Y, Kang S. et al. Malignant obstruction of gastric outlet and duodenum: palliation with flexible covered metallic stents. Radiology 2001; 219: 679-683
• 2 Yim H, Jacobson B, Saltzman J. et al. Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endosc 2001; 53: 329-332
• 3 Pinto Pabon I, Diaz L, Ruiz De Adana J. et al. Gastric and duodenal stents: follow-up and complications. Cardiovasc Intervent Radiol 2001; 24: 147-153
• 4 Lee H, Park JC, Shin SK. et al. Preliminary study of enteroscopy-guided, self-expandable metal stent placement for malignant small bowel obstruction. J Gastroenterol Hepatol 2012; 27: 1181-1186